(Form Fee Rs. 500/-)

Date of Issue : ------

TILAK MAHARASHTRA VIDYAPEETH, PUNE

Mukundnagar, Gultekdi, Pune 411037

(Declared u/s 3 of UGC Act 1956 vide Notification No. F9-19/85.U-3 dated 24 April 1987 by the Government of India)

FACULTY OF DISTANCE EDUCATION

APPLICATION FORM FOR INFORMATION CENTRE

Form Fee*, Processing Fee & Inspection Fee
(For distance upto 300 km.)
(To be paid while submitting form) / Accreditation Fee
(For 3 years) (Non-refundable)
(To be paid while receiving accreditation letter)
500/-+5,000/- = 5,500/-** / 5,000/-**

*While collecting form in person form fee (Rs. 500/-) should be paid in cash.

**Payment by Demand Draft only. Issue Demand Draft in the name of ‘Registrar, Tilak Maharashtra Vidyapeeth, Pune’

Submit the form at the Department of Distance Education, Tilak Maharashtra Vidyapeeth, Pune.

A)GENERAL INFORMATION

Name of Institute : ------

Address : ------

------

------

Pin : ------Taluka : ------District : ------

Phone No: ------Mobile No. : ------

(With STD code)

Fax No. : ------E-mail :

Type of Institute :

A)CollegeSchoolComputer Institute Other (Please Specify)

B)Trust Private`Society

C)Sole Proprietorship Partnership

Whether institute is registered : Yes No

Registration No. :

Name and Address of Head of the Institution : ------

------

------

------

Phone : Fax :

e-mail :

Name/s and Addresses of the Owners / Trustees:

1)------

------

------

------

Phone :

2)------

------

------

------

Phone :

  • Details of programmes conducted :

Sr. No. / Programmes / Duration / Affiliated to / Enrolment
1
2
3
4
5
  • About Institution’s Finance

1)Source of Income

2)A brief statement of Income and Expenditure for last 3 years

3)PAN

4)Details of Service Tax Registration (Enclose a copy)

  • Justification for opening centre

1)Of Tilak Maharashtra Vidyapeeth : ------

------

------

2)Of said programmes : ------

------

------

------

  • Expected No. of Admissions

B.A. (Social Sciences) / M.A. (Economics) / M.A.
(Political Science) / M.A. (Sociology) / M.A. (History)
M.A.
(Marathi) / M.A. (English) / M.A.
(Hindi) / B.Com / M.Com

B. INFRASTRUCTURE, MANPOWER AND FACILITIES

Expected / Actual
Infrastructure / 1 Office Room / (Mention area in sq. meters.)
Store Room
Wash room
facility of clean drinking water
1 PC with internet
Telephone
Fax machine
Class rooms for conducting examinations (Optional)
Computer Lab for conducting online examinations (Optional) (Mention no. of work stations available) Expected no. 1 work station after 2 students
Manpower / Administrative* / Name / Qualification
Centre Coordinator
(with graduation) / Shri/Smt.------
------
1 clerk with good knowledge of computer basics, / Shri/Smt.------
------
1 peon
(S.S.C.) / Shri/Smt.------
------

*Attach resume dully signed with passport size photograph.

C. RULES AND RESPONSIBILITIES

Responsibilities –

  • To admit the students online.
  • To submit hard copy of admission forms to admission section of the Vidyapeeth / Regional Office.
  • To distribute Study Material.
  • To collect Home Assignments and dispatch it to the Department of Distance Education
  • To provide assistance to Vidyapeeth if required for conduct of online &/or offline exam.
  • To distribute the result-sheets.
  • To attend the meetings and workshops arranged by the Vidyapeeth.

Rules and Regulations –

  • Logo of the Vidyapeeth should not be used on any of the documents.
  • Payment will be made as per following schedule - admission and service charges - at the end of year.
  • The Vidyapeeth will finalise the examination centre and hence no assurance should be given to the students in this regard.

Remunerations –

Heads / Rate
Administrative Charges (Per student) / 400/-
Exam. Charges (If examination duties assigned or examination centre is allotted) / As per Vidyapeeth rule.

(Keep a copy of ‘Rules and Responsibilities’ for your record.)

D. DECLARATION

I hereby, declare that all information stated in this application is true to my knowledge. I will abide by the rules, regulations and guidelines of Tilak Maharashtra Vidyapeeth and Distance Education Council (DEC), New Delhi.

Date : Signature/s : ------

Seal : ------

Note :

If institution is trust or society, application should be signed by Chairman of a Trust / society.

If institution is in partnership application should bear signatures of all partners.

Annexures :

Address proof

Attested copy of Registration Certificate Application for Information Centre

Photographs of InfrastructureResume with photographs of faculty members

Resume with photograph of head of institution

Authority letter (with photograph) for signatory (If owner of institute appoints representative)

Page 1